Knee replacement recovery: what to expect

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From effective pain control to regaining mobility and getting back to daily life

A Mediclinic expert explains what you need to know about recovery from a knee replacement.

Pain control for knee replacements

Pain control for knee replacements is divided into perioperative (in-hospital) and postoperative treatment. “We use a multi-modal pain control approach, using a combination of different drugs to minimise or control the pain,” explains Dr André Olivier, an orthopaedic surgeon at Mediclinic Vergelegen. “In this way we can find the optimal balance between the painkilling effect of the medications and their potential side-effects.”

Before their surgery, patients at Mediclinic hospitals usually visit a pre-admission clinic and meet with the anaesthetist. This helps ensure you get the right pain relief at the lowest effective dose. It also allows the team to check any ongoing medications you are taking, so they don’t interfere with your care during the procedure, says Dr Olivier.

During surgery, pain relief can include epidural anaesthesia, which is an injection in the back to block pain, or general anaesthesia, a medically induced temporary loss of consciousness. The anaesthetist may also use a local block to numb specific nerves, like those around the knee. Dr Oliver says some pain medications given during surgery will remain effective for 6-12 hours after the procedure.

After surgery, you may be given a combination of pain relievers. Dr Olivier says the aim is always to make the course of pain medication as short as possible. “We try to encourage as little use of opioids as possible,” he adds, “because of the side-effects of nausea, sedation, respiratory suppression, constipation and, most importantly, the potential for dependency”.

It’s normal to have swelling and redness around your knee after a knee replacement. You can use ice packs as directed by the physiotherapist on your discharge from the hospital. If you have any major concerns, contact your doctor, advises Dr Olivier.

Exercise after a knee replacement

Before the surgery, you'll meet with a physiotherapist who will explain what to expect and what adjustments you may need to make at home. For instance, you might need to move a bed downstairs since you’ll likely be using crutches or a walking frame for the first few weeks. The physiotherapist will also discuss the exercises you’ll need to do after the operation and provide you with information to help guide your exercise routine in the weeks following your surgery.

Your physiotherapist will aim to get you mobile as soon as possible, sometimes within hours or a day of the surgery, depending on the side-effects of the pain medication.

“While you have to wait a few weeks for the wound to heal before you can exercise vigorously, I advise patients to walk as much as possible, preferably every day, as this helps to reduce the swelling and improves mobility,” says Dr Olivier. “It’s also very good for your overall wellbeing to get out.”

Returning home after a knee replacement

Dr Olivier says he tells his patients they can go home when he is satisfied with the wound, when they are feeling well, and when the physiotherapist believes they are safe in terms of mobility and independence.

“There is a trend to do joint replacements on an outpatient basis, meaning you come in and go out on the same day. That is for a very select group of patients and is not the norm. Normally patients can go home in 2-4 days, especially for the older population,” he says, adding that most of his patients are aged 75 or older and not physically strong enough to get up and go.

Dr Olivier says the recommended recovery period at home after a knee replacement is six weeks. “While this can vary depending on each patient’s specific situation, most patients tend to be more mobile after six weeks, with reduced swelling and manageable pain, allowing them to return to their previous level of function.”